Sugar MADNESS:How metabolic syndrome drives obesity

and what you can do about it

Tomas J. Aragon, MD, DrPH

Health Officer, City & County of San FranciscoDirector, Population Health Division (PHD)San Francisco Department of Public Health

Adjunct Faculty, Division of EpidemiologyUC Berkeley School of Public Health

Email: tomas.aragon@sfdph.orgBlog: http://medepi.com

February 16, 2014

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 1 / 14

Acknowledgments (in alphabetical order)

Beatrice Cardenas-Duncan, Shape Up San Francisco

Charles M. Collins, Shape Up San Francisco

Christina Goette, MPH, SFDPH

Laura A. Schmidt, PhD, MSW, MPH, UCSF

Marianne Szeto, MPH, SFDPH

Robert H. Lustig, MD, MSL, UCSF

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 2 / 14

Overview

1 What is the Sugar MADNESS?

2 What is the diagnosis? → M-A-DMetabolic syndromeAddictive potential of sugarDisordered fat (energy) storage

3 What is the treatment? → N-E-S-SNutritionEnvironmentsStress reductionSleep and exercise

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 3 / 14

What is the Sugar MADNESS?

What is the Sugar MADNESS?

Sugar

Sugar consumption, especially from sugary drinks, is the single largest andpreventable contributor to the global epidemic of diabetes, heart disease,high blood pressure, bad cholesterol, and unhealthy weight gain.

Fructose

Fructose is the part of “sugar” that is the culprit. Fructose in liquid formis worse! Fructose is metabolized by the liver. With repeated exposures, itcauses fatty liver, high insulin, insulin resistance, excessive fat storage, andleptin resistance. We call this metabolic syndrome. Our brain believes wehave less fat stored than we need. Hence, we eat more and move less.

Metabolic syndrome

It’s a complicated, but important story: Sugar MADNESS is a memoryaid to learning about sugar, metabolic syndrome, and what to do about it.

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 4 / 14

What is the Sugar MADNESS?

Use Sugar MADNESS to remember the cause (sugar),the diagnosis (MAD), and the treatment (NESS)

Diagnosis

M etabolic syndrome

A ddictive potential of sugar

D isordered fat storage

Treatment

N utrition

E nvironments

S tress reduction

S leep and exercise

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 5 / 14

What is the diagnosis? → M-A-D Metabolic syndrome

Metabolic syndrome is the key condition, not obesity

Figure : Humans evolved with occasional natural fructose from fruits. Today,especially since 1980, our livers are insulted daily with fructose from added sugars,especially from liquid sources (e.g., sodas, juices, energy and sport drinks),contributing to metabolic syndrome. Source: UCTV The Skinny on Obesity

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 6 / 14

What is the diagnosis? → M-A-D Addictive potential of sugar

Addictive potential of sugar, especially with added salt,fats, or caffeine

Figure : Make no mistake: food is designed to build brand loyality. In some, sugartriggers reward centers in the brain and induces sugar cravings. Source: AhmedSH, Guillem K, Vandaele Y. Sugar addiction: pushing the drug-sugar analogy tothe limit. Curr Opin Clin Nutr Metab Care. 2013;16(4):434-9. PMID: 23719144.

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 7 / 14

What is the diagnosis? → M-A-D Disordered fat (energy) storage

Disordered fat storage drives behavior to eat more andmove less

Metabolic syndrome (MetS) results in disordered fat storage.

Biochemistry

Chronic high insulin

Leptin resistance (LR)

Leptin (from fat cells)not able to notify brainthat sufficient fat hasbeen stored; therefore,

MetS drives behavior to:

Eat more

Move less (↓ exercise)Figure : Source: UCTV The Skinny on Obesity

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 8 / 14

What is the treatment? → N-E-S-S Nutrition

Nutrition is key to better metabolic health

Avoid added sugars (i.e., fructose)

Sodas

Fruit juices

Sports drinks

Energy drinks

Chocolate milk, etc.

Add back real (unprocessed) food

Fiber, omega-3 fatty acids, andmicronutrients

Hu FB. Resolved: There is sufficient scientific evidence thatdecreasing sugar-sweetened beverage consumption will reducethe prevalence of obesity and obesity-related diseases. ObesRev. 2013;14(8):606-19.

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 9 / 14

What is the treatment? → N-E-S-S Environments

Environments—make healthy choices easy everywhere

Current state

Fast food available 24/7

Soda vending machines

Targeted advertising (see billboard)

Processed foods with added sugarand removed fiber

Future state

Water instead of sugary drinks

Portion sizes reduced

Fresh food affordable and available

Healthy food policies and systems

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 10 / 14

What is the treatment? → N-E-S-S Stress reduction

Stress reduction improves your metabolic health

Bottom line: Chronic stress promotes unhealthy weight gain.

Figure : Abbreviations: HP, highly palatable; HPA, hypothalamic-pituitary-adrenal; GC,glucocorticoids; Source: Sinha R, Jastreboff AM. Stress as a common risk factor for obesity andaddiction. Biol Psychiatry. 2013;73(9):827-35. doi: 10.1016/j.biopsych.2013.01.032. PMID:23541000

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 11 / 14

What is the treatment? → N-E-S-S Sleep and exercise

Sleep and exercise improves your metabolic health

Sleep

Less than adequate sleepresults in ↓ leptin and↑ ghrelin → weight gain(↑ body mass index)

http://news.stanford.edu/news/2004/december8/med-sleep-1208.html

Exercise

Exercise regulates fat and glucose metabolism and results in an increasedaction of insulin, while it also lowers blood pressure and improves bloodpressure control in overweight adult subjects.Source: Golbidi S, Mesdaghinia A, Laher I. Exercise in the metabolic syndrome. Oxid Med Cell Longev. 2012;2012:349710. doi:10.1155/2012/349710. PMID: 22829955

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What is the treatment? → N-E-S-S Sleep and exercise

Remember, Sugar MADNESS summarizes the cause(sugar), the diagnosis (MAD), and the treatment (NESS)

Diagnosis

M etabolic syndrome

A ddictive potential of sugar

D isordered fat storage

Treatment

N utrition

E nvironments

S tress reduction

S leep and exercise

Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 13 / 14

What is the treatment? → N-E-S-S Sleep and exercise

Resources

Choose Healthy Drinkshttp://www.choosehealthydrinks.org/

Shape UP San Franciscohttp://shapeupsfcoalition.org/

The Skinny on Obesity—UCTV Primehttp://www.uctv.tv/skinny-on-obesity/

Robert H. Lustig. Fat Chance: Beating the Odds Against Sugar,Processed Food, Obesity, and Disease. Plume Publishing 2012

HBO’s The Weight of the Nationhttp://theweightofthenation.hbo.com/

Gary Taubes. Why We Get Fat: And What to Do About It. AnchorPublishing, 2010

CDC. Overweight and Obesity : http://www.cdc.gov/obesity/

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